HB 4735

Summary

As introduced: - Prohibits a health insurance issuer from using an automated process, including artificial intelligence, to downcode a medical claim. - Requires downcoding decisions to be made by a physician of the same or similar specialty as the treating physician after a documented review of clinical information. - Prohibits a health insurance issuer from downcoding a claim based solely on the reported diagnosis codes or in a manner that discriminates against physicians who treat patients with complex or chronic conditions. - Establishes notification requirements for issuers and an appeal process for physicians for any downcoded claims. - Exempts employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act.

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